From what I can tell, low-margin companies just buy walmart computers and use AOL email accounts.

Once they are in the 10-20 employee range they start looking for either a part-timer or a managed service provider (MSP). They'll also want this if they have basically any compliance targets (most of mine get audited by the FDIC or a reinsurer).

On the MSP side we use an RMM tool to automate workstation and server management across all our clients, handle audits, plan their infrastructure growth, manage the more complicated saas apps like O365/G-suite, etc.

Most basic companies are fairly hands-off once you have them in a good spot, I think I spent more time through coronavirus helping them iron down their bureaucracy re: WFH than actual technical challenges.

Very few of my clients are interested in India and geographic proximity plays a larger role in provider selection than any other factor. We get face2face with every client at least once a month and can actually show up to handle an issue when needed.

I used to work for a company that provided "outsourced business process services" to public and private sector clients, and about half the employees were in India, but half not. Last I knew, they weren't making much if any money though. But my point is, yes, everything gets outsourced, but plenty of outsourcing goes to Americans or wherever.